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Abdolahtabar H, Sajjadi H. (2024). Social Policy and Changes in the Health System in Iran. refahj. 24(94), : 1 doi:10.32598/refahj.24.94.2810.3
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Extended Abstract
Introduction
After the establishment of the modern government in Iran in 1304 (Abrahamian, 2014), the official structures of the health system were gradually established, and health policymaking, like other areas of social life, is considered one of the duties of the government. The health system in Iran has seen many developments and changes during the past 9 decades, which have resulted in various consequences. Among the major achievements of these developments and changes are the improvement of health indicators, better physical and financial access of people to health services, increase in life expectancy, control of population growth, control of infectious diseases, training of manpower and development of required physical resources, which is partially rooted in policy making (Nasrullahpour Shirvani and Maouodi, 2013). Mentioned the appropriate ones; But despite these achievements, the persistence of problems in some areas shows the need to pay attention to the role of other factors, especially social factors, as well as strategies related to health policy (Sajjadi et al. 2008). The purpose of this article was to clarify the path taken in the structure of Iran’s health system and the factors affecting health policy from the beginning to 2016. In this regard, it is intended to answer the following questions: What events have been effective in the formation of the health system in Iran? What are the events affecting the evolution of the health system and what has been their effect on health policy?
Method
The method of conducting the present research is of a historical type, which is based on the collection of data from reliable historical sources related to the health system in Iran (including medicine, health, etc.). The path dependence method is also used for data analysis, which researchers such as Morgan and others (1985) and Armstrong and Tawakol (2017) have confirmed its applicability in the field of medicine and health (Naseri Rad, 2012). In this research, the first three types of sources were used and according to the research objectives, the sources that met the following criteria were selected: historical sources about the history of medicine and contemporary medicine in Iran (with an emphasis on first-hand sources); Historical sources about the history of Iran’s political, social, economic and cultural developments, which the author considered the simultaneous role of these factors and their internal relationships with each other; The main text of the laws and regulations compiled in the field of health, including the laws related to the organizational structure of the health system and health and treatment policies; The main text of construction plans before the revolution and development plans after the revolution; The report of health activities and indicators provided by the official body in charge of health, i.e. the Ministry of Health or the Ministry of Health, Treatment and Medical Education, and texts that reviewed, evaluated and compared the performance of construction and development programs or policies of the health sector.
Findings
After reviewing the historical sources during the research, it was found that despite the initial premise of the research, which considers the formation of the modern government in 1304 as the beginning of the health system in Iran, the starting point of the current path of the health system should be the time of the establishment of Dar al-Funun and the bringing of European doctors to Iran considered modern medicine education (1228), which provided the grounds for changing the structure of traditional medicine to modern medicine and creating the foundations of the health system in Iran. In fact, the first critical event in the path of the health system is the establishment of Dar al-Funun. The path dependency analysis method that was used to investigate the evolution of the health system in Iran showed that it is possible to determine two parallel sequences in the course of political and social changes in Iran, with an emphasis on social policy, during which 11 important and influential events took place. And three critical joints were identified (Figure 3). Sequence 1 is known as “Demand for Social Justice”, which begins with the Constitutional Revolution, which was the direct result of the establishment of Dar al-Funun and the familiarization of intellectuals and common people with their political and social rights, and has become the source of extensive changes in Iran. Sequence 2 is also known as “Modernization of Iran” which starts with the establishment of the Pahlavi government. At the first critical point, sequence 1 and sequence 2 intersected when the Qajar government changed to Pahlavi, but due to the government’s inattention to the National Assembly, the social policy and policy of the newly established government did not have much effect on the demand for social justice and the modernization of the country. Government programs and policies were placed; As a result, this intersection is called a “vital joint of unstable consequence”. The second critical moment occurred during the second Pahlavi period and in the story of the nationalization of the oil industry and Dr. Mossadegh’s prime minister ship; But after two years with the coup d’état of August 28, 2012, this joint was not able to make deep structural changes in goals and policies, and this intersection is also called “a vital joint with unsustainable consequences”. The third joint of these two sequences is the “occurrence of the Islamic Revolution of 1357” which led to the change of the pillars of government and the attitude and policies of the ruling powers, hence it is known as “the joint with lasting consequences”; However, this fundamental change has not been very successful due to the stability of the characteristics of the governments before the revolution, including the extensive intervention of the government in the economy, the dependence of the government and its programs on oil revenues, and the weakness of the ability to make policies, the process of establishing social justice has not been very successful.
Discussion:
The change of governments and the adoption of different policies in the field of health have not been able to help eliminate inequality and injustice in the field of health, although there have been successes in some fields, including health. The last point that should be noted is that many of the plans and programs that were implemented in the country at a certain time are justified under the influence of the historical conditions of that time; And questioning the decisions and policies adopted does not help to improve the situation, but what is important is to pay attention to the contexts and factors affecting the adoption of macro-decisions and policies derived from them, and to learn from previous events and to make more responsible decisions in the future, just as inattention The policies adopted in the past and ignoring their consequences have brought a lot of costs to the health system.
Ethical considerations
Contribution of authors
The article was prepared with the participation of both authors, and the responsible author of the article is Dr. Hadi Abdolahtabar.
Financial resources
This article is not sponsored.
Conflict of interest
There is no conflict of interest in this article.
Ethical principles in research
In this article, all ethical principles in the field of plagiarism, data distortion, etc. have been observed.
Introduction
After the establishment of the modern government in Iran in 1304 (Abrahamian, 2014), the official structures of the health system were gradually established, and health policymaking, like other areas of social life, is considered one of the duties of the government. The health system in Iran has seen many developments and changes during the past 9 decades, which have resulted in various consequences. Among the major achievements of these developments and changes are the improvement of health indicators, better physical and financial access of people to health services, increase in life expectancy, control of population growth, control of infectious diseases, training of manpower and development of required physical resources, which is partially rooted in policy making (Nasrullahpour Shirvani and Maouodi, 2013). Mentioned the appropriate ones; But despite these achievements, the persistence of problems in some areas shows the need to pay attention to the role of other factors, especially social factors, as well as strategies related to health policy (Sajjadi et al. 2008). The purpose of this article was to clarify the path taken in the structure of Iran’s health system and the factors affecting health policy from the beginning to 2016. In this regard, it is intended to answer the following questions: What events have been effective in the formation of the health system in Iran? What are the events affecting the evolution of the health system and what has been their effect on health policy?
Method
The method of conducting the present research is of a historical type, which is based on the collection of data from reliable historical sources related to the health system in Iran (including medicine, health, etc.). The path dependence method is also used for data analysis, which researchers such as Morgan and others (1985) and Armstrong and Tawakol (2017) have confirmed its applicability in the field of medicine and health (Naseri Rad, 2012). In this research, the first three types of sources were used and according to the research objectives, the sources that met the following criteria were selected: historical sources about the history of medicine and contemporary medicine in Iran (with an emphasis on first-hand sources); Historical sources about the history of Iran’s political, social, economic and cultural developments, which the author considered the simultaneous role of these factors and their internal relationships with each other; The main text of the laws and regulations compiled in the field of health, including the laws related to the organizational structure of the health system and health and treatment policies; The main text of construction plans before the revolution and development plans after the revolution; The report of health activities and indicators provided by the official body in charge of health, i.e. the Ministry of Health or the Ministry of Health, Treatment and Medical Education, and texts that reviewed, evaluated and compared the performance of construction and development programs or policies of the health sector.
Findings
After reviewing the historical sources during the research, it was found that despite the initial premise of the research, which considers the formation of the modern government in 1304 as the beginning of the health system in Iran, the starting point of the current path of the health system should be the time of the establishment of Dar al-Funun and the bringing of European doctors to Iran considered modern medicine education (1228), which provided the grounds for changing the structure of traditional medicine to modern medicine and creating the foundations of the health system in Iran. In fact, the first critical event in the path of the health system is the establishment of Dar al-Funun. The path dependency analysis method that was used to investigate the evolution of the health system in Iran showed that it is possible to determine two parallel sequences in the course of political and social changes in Iran, with an emphasis on social policy, during which 11 important and influential events took place. And three critical joints were identified (Figure 3). Sequence 1 is known as “Demand for Social Justice”, which begins with the Constitutional Revolution, which was the direct result of the establishment of Dar al-Funun and the familiarization of intellectuals and common people with their political and social rights, and has become the source of extensive changes in Iran. Sequence 2 is also known as “Modernization of Iran” which starts with the establishment of the Pahlavi government. At the first critical point, sequence 1 and sequence 2 intersected when the Qajar government changed to Pahlavi, but due to the government’s inattention to the National Assembly, the social policy and policy of the newly established government did not have much effect on the demand for social justice and the modernization of the country. Government programs and policies were placed; As a result, this intersection is called a “vital joint of unstable consequence”. The second critical moment occurred during the second Pahlavi period and in the story of the nationalization of the oil industry and Dr. Mossadegh’s prime minister ship; But after two years with the coup d’état of August 28, 2012, this joint was not able to make deep structural changes in goals and policies, and this intersection is also called “a vital joint with unsustainable consequences”. The third joint of these two sequences is the “occurrence of the Islamic Revolution of 1357” which led to the change of the pillars of government and the attitude and policies of the ruling powers, hence it is known as “the joint with lasting consequences”; However, this fundamental change has not been very successful due to the stability of the characteristics of the governments before the revolution, including the extensive intervention of the government in the economy, the dependence of the government and its programs on oil revenues, and the weakness of the ability to make policies, the process of establishing social justice has not been very successful.
Fig 1. Path dependency model of social political developments in Iran
The change of governments and the adoption of different policies in the field of health have not been able to help eliminate inequality and injustice in the field of health, although there have been successes in some fields, including health. The last point that should be noted is that many of the plans and programs that were implemented in the country at a certain time are justified under the influence of the historical conditions of that time; And questioning the decisions and policies adopted does not help to improve the situation, but what is important is to pay attention to the contexts and factors affecting the adoption of macro-decisions and policies derived from them, and to learn from previous events and to make more responsible decisions in the future, just as inattention The policies adopted in the past and ignoring their consequences have brought a lot of costs to the health system.
Ethical considerations
Contribution of authors
The article was prepared with the participation of both authors, and the responsible author of the article is Dr. Hadi Abdolahtabar.
Financial resources
This article is not sponsored.
Conflict of interest
There is no conflict of interest in this article.
Ethical principles in research
In this article, all ethical principles in the field of plagiarism, data distortion, etc. have been observed.
Type of Study: orginal |
Received: 2023/10/28 | Accepted: 2024/05/6 | Published: 2024/10/5
Received: 2023/10/28 | Accepted: 2024/05/6 | Published: 2024/10/5
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